Preventing inappropriate antibiotic use

A collaboration between scientists has helped reduce the prescription of unneeded antibiotics to children in rural China.

Young people in some areas of the country are being given antibiotics, often intravenously,
to treat a cold, ear or throat infections  but the drugs are not effective
against virus-based illnesses.

The inappropriate use of antibiotics is a major risk factor in
the development of drug-resistant "superbugs".

Antibiotic use halved

The collaboration brought together rural hospitals in two
counties in rural China, Chinese health officials and academics at the
University of Leeds (COMDIS) and the University of Toronto.

Doctors come under considerable pressure from parents to prescribe antibiotics to children...

Professor John Walley, Professor of International Public Health

The aim was to devise and evaluate a system of "anti-microbial
stewardship" that could be used in other parts of the Chinese health system and
would give doctors the confidence to say no to requests for inappropriate
antibiotic treatment.

The stewardship programme was rolled out to a group of primary
care hospitals in in Guangxi province in Southern China.

Much of the demand for antibiotics in the Chinese primary care
sector comes from parents and grandparents who have children with upper
respiratory tract infections such as a sore throat or earache.

John Walley, Professor of International Public Health at the
University of Leeds, said: Doctors working in the primary care hospitals come
under considerable pressure from parents to prescribe antibiotics to children
who have upper respiratory tract infections.

They can feel that if they dont give the antibiotic, the
parents will just go elsewhere and get it.

These are difficult decisions for the doctor. They may have a
very ill child in front of them  and they do not have a battery of tests
results to rely on. They are having to make a clinical judgement about the
risks involved in not giving antibiotics.

New guidelines for doctors

University academics and Chinese experts drew up clinical
guidelines based on those produced by the UKs National Institute for Health
and Care Excellence to help doctors decide when it would be appropriate to
prescribe antibiotics and alert them to the warning signs of more serious
illness.

Two groups of primary-care hospitals in Guangxi were selected
for the evaluation. Baseline data was collected about the prescribing practices for
children attending with upper respiratory tract infections.

In the first group, containing 12 hospitals, doctors received
training in how to explain to parents why antibiotics are not necessary.
Medical managers also conducted monthly prescription reviews, to monitor
doctors compliance with the guidelines.

In the second group, made up of 13 hospitals, medical staff
continued to prescribe in the usual way.

Six months later, several thousand prescriptions were selected
at random from the two groups and compared with the baseline findings. The
results showed that in the group that had received stewardship training, the
antibiotic prescription rate had dropped from 82 per cent to 40 per cent. In
the business-as-usual group, the rate went from 75 per cent to 70 per cent.

Taking account of statistical issues, the researchers say the
stewardship programme resulted in a 48 per cent reduction in the prescribing rate of
antibiotics for children with upper respiratory tract infections.

Professor Walley said: There have been other approaches that
have tried to change the behaviour of doctors and patients  but none has
delivered the scale of change that we have seen.

Typically in successful trials the change is between five and 25
per cent.

The Chinese Health Ministry has policies to reduce antibiotic
use but the challenge is to get that aim delivered in primary care clinics and
hospitals, Professor Walley said.

He said the key to success was to "embed" stewardship programmes within the health system, giving doctors the skills and encouragement to
give antibiotics when there is a real clinical need  and to refuse them when their use would be inappropriate.

The problem of the overuse of antibiotics exists in many low and
middle income countries, and existed in the UK  although healthcare policies
in recent decades have resulted in more careful use of antibiotics.

For more information, please contact David Lewis in the University of Leeds press office via d.lewis@leeds.ac.uk or 0113 343 8059.